Faculty of Medicine

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    SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS IN HEART FAILURE
    (MIT University Skopje, 2023)
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    Tonev, Jelena
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    Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are antidiabetic drugs whose therapeutic action has gone beyond diabetes and extended to the cardiovascular and renal systems. They are class I evidence, guideline-directed medical therapy in heart failure irrespective of ejection fraction or diabetes mellitus. There are several assumptions about the mechanism of their action, but the exact mechanism has not yet been determined. Every doctor should be familiar with these new drugs for the implementation of their uses and better recognize and limit side effects.
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    Dilated cardiomyopathy in acromegaly - Case report
    (2014-10)
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    Todorova, Biljana
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    Introduction: Patients diagnosed with acromegaly develop many cardiovascular complications such as hypertension, arrhythmia, systolic and diastolic dysfunction, valvular dysfunction and heart failure. Dilated cardiomyopathy (DCM) with systolic and diastolic dysfunction is relatively rare but is associated with high mortality to 60%. In MCC the heart muscle gradually dilate and the dysfunction that develops is irreversible. It is therefore necessary early diagnosis and treatment of acromegaly by removal of the tumor and drug treatment with drugs that prevent the heart failure. Material and methods: We present a case of acromegaly diagnosed at the patient at the age of 27 with pituitary macroadenom, hipopituitarizam, diabetes,insipiden diabetes and atrophy of the optic nerve. The patient was subjected to endoscopic surgery but the disease remained active and she was treated with radiotherapy. Our patient has ignored the underlying disease and didn’t call in to the review and controls. The patient was hospitalized with difficult situation of heart failure with anasarca, hypertension, fatigue and severe left ventricular dysfunction with global hypocinesia in the Clinic for Cardiology. She was treated with diuretics, cardiotonics, vasodilators and hormone replacement therapy. Conclusion: Early diagnosis and prompt treatment of acromegaly can prevent irreversible cardiomyopathy. The problem is greater, if it is associated with other morbidities such as hypertension and diabetes.
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    Prognosticators of heart failure in patients after treatment because of acute coronary syndrome
    (2016-05)
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    Bekim Pocesta
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    Gorjan Krstevski
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    Hajber Taravari
    Aim of the study was to identify frequency and predictors of heart failure in patients treated for acute coronary syndrome (ACS). Patients and methods: Patients with ACS treated medically or with PCI, were extracted from the hospital registry. Analyzed variables: age, gender, risk factors, SBP and HR at hospital admition, type of MI, location, CAD severity, LV function, type of treatment, in-hospital morbidity, pharmacologic treatment post discharge, time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 437 patients treated for ACS, at mean age 63,2±11,1 years, 294(67,3%) males and 143(32,7%) females, were followed up for mean 17,3±10,3 months. A total of 128(29,3%) patients had 136 cardiac events (CE), 32(25%) of whom heart failure (HF). Mean time to HF was 5,9±7,4 (SE), CI(3,3-8,6) (Figure 1). As univariate predictors of HF in ACS treated patients we identified: length of hospitalization (for ACS treatment) 3,9±2,2 vs 5±2,5 days (beta .169, p=0,009); diuretic utilization during ACS hospitalization (beta 1.992, p=0,001); EF (%) (beta -0.092, p=0,001); reduced EF (<40%) had OR for HF 3.282 (CI 1,129-9,542, p=0,011); receiving PPCI (beta -1.584, p=0,011, exp(B) 0.205); known DM (beta0.741, p=0,007, exp(B) 2,098); previous MI (beta 0.832, p=0,068, exp(B) 2,297); statin therapy prior ACS (beta-0.955, p=0,028, exp(B) 0,385); PCI performed (beta-0.990, p=0,043, exp(B) 0,372); in-hospital morbidity (beta 0.868, p=0.028, exp(B) 2,382). In multivariate analyze (binary logistic regression) four independent predictors were identified: known diabetes (p=0,004), PCI treatment for ACS (p=0,006), diuretic therapy during ACS hospitalization (p=0,004) and LV function (p=0,024). Conclusion: Predictors of HF development in pts. after ACS, seems to be preexisting DM, need for diuretic therapy during ACS event, and reduced LV systolic function as negative ones, but, receiving PCI (myocardial revascularization) is the most important positive predictor.
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    Functional outcome and quality of life after coronary artery bypass surgery in patients with severe heart failure and hibernated myocardium
    (Wolters Kluwer, 2008-03-29)
    Peovska, Irena
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    Maksimovic, Jelena
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    Background: Myocardial viability is an important parameter, predictive of improvement in left ventricular function after coronary artery bypass surgery (CABG). We wanted to define the relationship between the extent of hibernated myocardium and improvement in ejection fraction function and quality of life after CABG. Methods: Sixty-five consecutive patients with ischaemic cardiomyopathy (mean LVEF <40%) undergoing surgical revascularization were studied with (99m)Tc-sestamibi myocardial perfusion Gated SPECT imaging (MPI) to assess preoperative myocardial viability. Patients were divided into two groups, based on the extent of viable myocardium before CABG: group 1, 39 patients with more than four viable segments; and group 2, 26 patients with fewer than four viable segments. Regional and global ejection fraction function, heart failure symptoms and quality of life were measured before and 14+/-4 months after revascularization. We used bull's eye quantitative analysis of MPI scans and a 17-segment model of ejection fraction function and perfusion evaluation. Results: The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r=0.79, P<0.01). Patients with more than four viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79%, respectively, for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms and quality of life after revascularization. Conclusion: The presence of more than four viable segments (24% of the left ventricle) on MPI in patients with ischaemic heart failure before CABG surgery is significantly correlated with the improvement in LVEF, heart failure symptoms and quality of life post-operatively.